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      Bilateral gluteus medius and minimus calcific tendonitis in a patient with previous bilateral calcific tendonitis of the shoulder: A case report

      case-report
      Author(s): , MBBS, iBSc, FRCR a , * , , MBBS, MRCGP b , , MBBS, PhD, FRCP a , , MBBS, D'Orth, FCPS, MS, MCh.Orth, FRCS Orth c , , MBBS, MRCS, MS, FRCR a
      Publication date (Electronic):
      Journal: Radiology Case Reports
      Publisher: Elsevier
      Keywords: Calcific, Tendonitis, Musculoskeletal, Gluteus, Tendinopathy

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          Abstract

          Calcific tendonitis of the gluteus medius and minimus tendons is a rare complication of hydroxyapatite deposition disease, with bilateral involvement even more so. Although patients can be asymptomatic, there is often an acute-on-chronic presentation of pain. We present a case of bilateral calcific tendonitis of the gluteus medius and minimus tendons on a background of previous bilateral rotator cuff calcific tendonitis in a middle-aged woman. This patient's long-standing history of multi-focal involvement required a multidisciplinary approach between orthopedics, rheumatology, and musculoskeletal radiology for optimal management, requiring different treatment options for different affected sites.

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          Calcific Tendinopathy of the Rotator Cuff: Pathogenesis, Diagnosis, and Management.

          Sarah Loehr, Hans K Uhthoff (1997)
          Calcific tendinopathy, or calcifying tendinitis, is a disease characterized by multifocal, cell-mediated calcification of living tissue. After spontaneous disappearance of the calcific deposits or, less frequently, surgical removal, the tendon reconstitutes itself. Attention to the clinical presentation and the radiologic, morphologic, and gross characteristics of the calcium deposit will facilitate differentiation between the formative phase and the resorptive phase, which is of paramount importance in the management of this disease. Should conservative treatment fail, surgical removal may be indicated during the formative phase, but only under exceptional circumstances during the resorptive phase. Aspiration and lavage of the deposit should be performed only during the latter phase.
          Article 0 comments Cited 51 times – based on 0 reviews     Review now
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            Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management

            Alison Grimaldi, Rebecca Mellor, Paul Hodges … (2015)
            Tendinopathy of the gluteus medius and gluteus minimus tendons is now recognized as a primary local source of lateral hip pain. The condition mostly occurs in mid-life both in athletes and in subjects who do not regularly exercise. Females are afflicted more than males. This condition interferes with sleep (side lying) and common weight-bearing tasks, which makes it a debilitating musculoskeletal condition with a significant impact. Mechanical loading drives the biological processes within a tendon and determines its structural form and load-bearing capacity. The combination of excessive compression and high tensile loads within tendons are thought to be most damaging. The available evidence suggests that joint position (particularly excessive hip adduction), together with muscle and bone elements, are key factors in gluteal tendinopathy. These factors provide a basis for a clinical reasoning process in the assessment and management of a patient presenting with localized lateral hip pain from gluteal tendinopathy. Currently, there is a lack of consensus as to which clinical examination tests provide best diagnostic utility. On the basis of the few diagnostic utility studies and the current understanding of the pathomechanics of gluteal tendinopathy, we propose that a battery of clinical tests utilizing a combination of provocative compressive and tensile loads is currently best practice in its assessment. Management of this condition commonly involves corticosteroid injection, exercise or shock wave therapy, with surgery reserved for recalcitrant cases. There is a dearth of evidence for any treatments, so the approach we recommend involves managing the load on the tendons through exercise and education on the underlying pathomechanics.
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              Calcific tendinitis: a pictorial review.

              Daniel S Siegal, Jim Wu, Joel Newman … (2009)
              Calcific tendinitis is caused by the pathologic deposition of calcium hydroxyapatite crystals in tendons and is a common cause of joint pain. The disease typically affects the shoulder and hip, with characteristic imaging findings; however, any joint can be involved. Occasionally, calcific tendinitis can mimic aggressive disorders, such as infection and neoplasm, especially on magnetic resonance imaging. Radiologists should be familiar with the imaging findings to distinguish calcific tendinitis from more aggressive processes. Image-guided percutaneous needle aspiration and steroid injection of calcific tendinitis are useful techniques performed by the radiologist for the treatment of symptomatic cases. Familiarity with these procedures and their imaging appearance is an important aspect in the management of this common disease.
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                Author and article information

                Contributors
                Mostafa Ellatif
                Journal
                Journal ID (nlm-ta): Radiol Case Rep
                Journal ID (iso-abbrev): Radiol Case Rep
                Title: Radiology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 1930-0433
                Publication date PMC-release: 26 August 2021
                Publication date Collection: November 2021
                Publication date (Electronic): 26 August 2021
                Volume: 16
                Issue: 11
                Pages: 3222-3225
                Affiliations
                [a ]London North West University Healthcare NHS Trust, London, England
                [b ]Practice Plus Group, London, England
                [c ]BMI The Clementine Churchill Hospital, London, England
                Author notes
                [* ] Corresponding author. mostafa.ellatif@ 123456nhs.net
                Article
                Publisher Item ID: S1930-0433(21)00546-X
                DOI: 10.1016/j.radcr.2021.07.074
                PMC ID: 8405919
                SO-VID: 50a0f6ce-460c-4224-bdeb-a894d143c99a
                Copyright © © 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 22 July 2021
                Date revision received : 25 July 2021
                Date accepted : 26 July 2021
                Categories
                Subject: Case Report

                Keywords: calcific,tendonitis,musculoskeletal,gluteus,tendinopathy
                Data availability:
                Keywords: calcific, tendonitis, musculoskeletal, gluteus, tendinopathy

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